Cholera

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Overview

 Cholera is an acute diarrhoeal infection caused by ingestion of contaminated water or food. It can lead to dehydration, and death in patients with severe forms of the disease. Cholera is an indicator of inequity and lack of social development. Its prevention and control should be multisectoral and well-coordinated integrating activities across sectors.

The Global Task Force for Cholera Control is a global partnership of >50 institutions that has a vision that collective action can stop cholera transmission and end cholera deaths. Its key role is to promote and support implementation of the Ending Cholera – a Global Roadmap to 2030 strategy at country level.

This introductory level course is intended for personnel responsible for prevention and control of cholera and for the ones involved in cholera outbreaks and response.

Symptoms

The characteristic symptoms of severe cholera are huge volumes of explosive watery diarrhea that sometimes is called "rice water stools" (because it resembles water that has been used to wash rice), vomiting, and leg cramps. The rapid loss of fluids—as much as 20 liters per day—can quickly lead to severe dehydration.


Signs of dehydration include skin turgor (meaning a section of skin that's pinched and is slow to return to normal position), sunken eyes, rapid heart rate, low blood pressure, and weight loss.


Shock can occur when the loss of fluid causes the circulatory system to collapse because there isn't as much blood, as usual, to flow through. Cholera doesn't usually cause a fever.


Causes

The microbe that causes cholera is a gram-negative bacteria called Vibrio cholerae. A person usually becomes infected with this bacteria by drinking water that's contaminated with feces from someone else who's infected. The bacteria also can be transmitted via foods that have been washed or prepared with contaminated water. It sometimes is transmitted via raw or undercooked shellfish. Person-to-person transmission is unlikely.

V. cholerae wreaks havoc on the digestive system by producing a toxin that disrupts the control and balance of fluid retention of mucosal cells within the intestines. Again, it generally does not cause a fever; the bacteria remain in the intestines.

Risk factors

Poor sanitary conditions. Cholera is more likely to flourish in situations where a sanitary environment — including a safe water supply — is difficult to maintain. ...

Reduced or nonexistent stomach acid. ...

Household exposure. ...

Type O blood. ...

Raw or undercooked shellfish.

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Complications

cholera is severe dehydration. The swift and significant onslaught of watery diarrhea, and sometimes vomiting, can quickly drain the body of fluids and electrolytes. If they aren't replaced in time, people can die within a matter of hours.

Low blood sugar (hypoglycemia). Dangerously low levels of blood sugar (glucose) — the body's main energy source — can occur when people become too ill to eat. ...

Low potassium levels. ...

Kidney failure.

Prevention

Although most cholera infections aren't severe, people infected with V. cholerae continue to shed the bacteria back into the environment, potentially infecting others with severe cholera disease. For this reason, the CDC recommends that anyone living in or traveling to places where cholera is found should drink boiled or chlorine- or iodine-treated water or bottled beverages. Foods should be thoroughly cooked, and individuals should peel their own fruits. Also, it's smart to be wary of ice, raw foods, ice cream, and any foods and beverages from street vendors. Frequent and thorough hand washing also is vital to avoiding cholera.


There are several vaccines for cholera, but only one, Vaxchora (lyophilized CVS 103-HgR), is available in the United States. It works by preventing severe diarrhea caused by the most common type of cholera and is recommended by the CDC for adults traveling to areas with active cholera transmission.